JACC. Case reports · 2026
Coronary Embolism Causing STEMI and Complete Heart Block During PTMC in Pregnancy.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Vijayvergiya Rajesh, Mukherjee Anirudh, Kumar Basant, Sharma Parminder
Аннотация
BACKGROUND: Severe rheumatic mitral stenosis during pregnancy carries high maternal-fetal risk. Percutaneous transvenous mitral commissurotomy (PTMC) is the guideline-recommended therapy.
CASE SUMMARY: A 33-year-old primigravida at 31 weeks' gestation with critical rheumatic mitral stenosis (mitral valve area: 0.47 cm2) and NYHA functional class III symptoms underwent urgent PTMC. Immediately after PTMC, she developed profound hypotension, complete heart block, and an inferior ST-segment elevation myocardial infarction (STEMI). Emergent coronary angiography revealed thrombotic occlusion of the mid right coronary artery with TIMI flow grade 0. Prompt mechanical thrombectomy restored TIMI flow grade 3. The patient delivered vaginally at 36 weeks, and both mother and neonate had favorable outcomes.
DISCUSSION: This case highlights the importance of early recognition of STEMI and demonstrates that a stentless percutaneous coronary intervention can successfully restore coronary flow.
TAKE-HOME MESSAGE: Immediate recognition of thrombotic occlusion of coronary artery during PTMC is essential for an emergent tailored stentless percutaneous coronary intervention during pregnancy.
CASE SUMMARY: A 33-year-old primigravida at 31 weeks' gestation with critical rheumatic mitral stenosis (mitral valve area: 0.47 cm2) and NYHA functional class III symptoms underwent urgent PTMC. Immediately after PTMC, she developed profound hypotension, complete heart block, and an inferior ST-segment elevation myocardial infarction (STEMI). Emergent coronary angiography revealed thrombotic occlusion of the mid right coronary artery with TIMI flow grade 0. Prompt mechanical thrombectomy restored TIMI flow grade 3. The patient delivered vaginally at 36 weeks, and both mother and neonate had favorable outcomes.
DISCUSSION: This case highlights the importance of early recognition of STEMI and demonstrates that a stentless percutaneous coronary intervention can successfully restore coronary flow.
TAKE-HOME MESSAGE: Immediate recognition of thrombotic occlusion of coronary artery during PTMC is essential for an emergent tailored stentless percutaneous coronary intervention during pregnancy.